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PSA Velocity and Prostate Cancer Mortality

Among men with localized prostate cancer, pre-diagnosis PSA velocity predicted cancer death after radiation therapy.

Using absolute prostate-specific antigen (PSA) thresholds to make decisions about diagnostic testing and biopsies remains controversial (Journal Watch Top Story Dec 31 2004), but PSA velocity (the rate at which PSA level rises) continues to be of interest. Researchers retrospectively evaluated the association between pre-diagnosis PSA velocity and mortality risk in 358 men who received external-beam radiation for localized prostate cancer.

Median PSA velocity in the year preceding diagnosis was 1.5 ng/mL. During a median follow-up of 4 years, the men experienced 160 episodes of PSA recurrence (elevated PSA levels after therapy) and 79 died, including 30 from prostate cancer. After adjustment for absolute PSA level, Gleason score, and tumor category, having PSA velocity >2 ng/mL was associated significantly with a 12-fold increased risk for prostate-cancer death and a 1.8-fold increased risk for PSA recurrence. Among patients with high-risk disease (defined by absolute PSA level, Gleason score, and tumor category), estimated 7-year absolute risk for prostate-cancer mortality was 24% in those with PSA velocity >2 ng/mL and 4% in those with PSA velocity 2 ng/mL. For patients with low-risk disease, corresponding estimates were 19% versus 0%.

Comment: These retrospective results are similar to those of a previous analysis of patients with localized prostate cancer who were treated with radical prostatectomy (Journal Watch Jul 13 2004). If replicated in prospective studies, these data could help identify high-risk patients who might benefit from androgen suppression therapy following radiation therapy.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine August 16, 2005

Citation(s):

D'Amico AV et al. Pretreatment PSA velocity and risk of death from prostate cancer following external beam radiation therapy. JAMA 2005 Jul 27; 294:440-7.

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